Diabetic ketoacidosis (peds)
Background
- DKA + AMS = cerebral edema until proven otherwise
Diagnosis
- Hyperglycemia (>200)
- Acidosis
- pH <=7.30 or bicarb <=15
- +ketonemia (>1:2 serum dilution)
Workup
- Point of care glucose (and potassium, if available)
- CBC
- Chem 7
- Magnesium
- Phosphorus
- Serum ketones (or beta-OH and acetone)
- UA
- Urine pregnancy (if appropriate)
- VBG
- Consider studies for possible infectious trigger
General Treatment
IV Fluids
- Bolus 20ml/kg NS x 1 (repeat boluses only for shock or poor perfusion)
- Replace fluid deficit evenly over 48hr w/ NS or 1/2 NS
- When BS <250:
- Change fluid to D51/2NS @ rate to correct fluid deficit in 48hr; maintain BS 150-250
Insulin
- IV Infusion 0.1 units/kg/hr
- Cont until HCO3 > 15 and pH>7.3
- Decrease infusion to 0.05 u/kg/hr until 1hr after SC insulin initiated
- IV Infusion 0.1 units/kg/hr
Potassium
- if < 2.5, hold insulin and give 1 meq/kg KCL in IV over 1hr
- No insulin until K > 2.5
- if > 2.5 but < 3.5 give 40-60 meq/L in IV until K > 3.5
- if > 3.5 but < 5.5 give 30-40 meq/L in IV for K=3.5 - 5
- if > 5.5, then check K q1hr
- if < 2.5, hold insulin and give 1 meq/kg KCL in IV over 1hr
Bicarbonate
- Only consider for:
- Critically ill (hemodynamic compromise from decr contractility) AND
- pH <7.0
- 0.5-2 mEq/kg over 1-2hr
- Correction should never exceed pH > 7.1 or bicarb >10
- Only consider for:
Disposion
- Admit all unless
- Known diabetes
- pH >7.35 and bicarb >20
- Known and resolving precipitant for DKA
Complications
See Also
Source
Tintinalli